This is the first study to investigate early cephalad adjacent segment degeneration following single-level posterior lumbar interbody fusion (PLIF) with cortical bone trajectory screw fixation for degenerative lumbar spondylolisthesis and to compare these results with those after single-level PLIF using traditional trajectory screw fixation for the same pathology.
Authors:Alessandro Siccoli, Victor E. Staartjes, Marlies P. de Wispelaere and Marc L. Schröder
The authors conducted an analysis of a prospective registry of patients who had undergone surgery for lumbar disc herniation. They determined whether late surgery is associated with worse outcomes and if there is a maximum time to surgery (waiting period) after which outcomes start to decline. It is vital to improve understanding of surgical timing and its influence on patient-reported outcomes. This knowledge is key to treatment planning, informed shared decision-making, and patient counseling.
Authors:Christopher D. Witiw, Nataliya Tsapenko and Vincent C. Traynelis
The authors present a series of 11 patients with primary neck pain who underwent cervical spine fusion after a finding of facet osteoarthritis and a positive radionucleotide imaging study. Significant improvements in patient-reported neck pain and neck disability were found at 12-month follow-up. This case series represents the largest available to date and adds support to a growing body of evidence that suggests the usefulness of radionucleotide imaging for identification of a cervical facetogenic pain generator.
In a retrospective cohort study, the authors investigated the clinical and radiological differences between 3-level cer-vical disc arthroplasty (CDA) and 3-level anterior cervical discectomy and fusion (ACDF). The study is important because it demonstrated the effectiveness and efficacy of 3-level CDA, which, unlike ACDF, not only successfully preserved but also slightly increased the mobility at the 3 index levels.
Authors:Samantha R. Horn, Peter G. Passias, Cheongeun Oh, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton Line, Neel Anand, Frank A. Segreto, Cole A. Bortz, Justin K. Scheer, Robert K. Eastlack, Vedat Deviren, Praveen V. Mummaneni, Alan H. Daniels, Paul Park, Pierce D. Nunley, Han Jo Kim, Eric O. Klineberg, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames and the International Spine Study Group
The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor overall outcome following cervical deformity (CD) corrective surgery. Identifying patient-specific factors that predict a poor outcome following CD surgery may help to improve patient outcomes.
Authors:Zach Pennington, Daniel Lubelski, Erick M. Westbroek, A. Karim Ahmed, Jeff Ehresman, Matthew L. Goodwin, Sheng-Fu Lo, Timothy F. Witham, Ali Bydon, Nicholas Theodore and Daniel M. Sciubba
The authors examined a 14-year series of patients who experienced C5 palsy following posterior cervical spine surgery. They investigated surgical and clinical predictors of the extent and timing of recovery following the onset of C5 palsy. They found that deltoid weakness at the time of C5 palsy diagnosis was the best predictor of both outcomes. The authors believe their results may be used by providers to help counsel and set expectations for patients suffering this complication.
The authors analyzed data from a series of patients who underwent surgery for thoracic ossification of the posterior longitudinal ligament (OPLL) and found that preoperative CT showed discontinuity between rostral and caudal ossified lesions in all but one of the patients. They compared measures of recovery in relationship to discontinuity or continuity of the OPLL at different postoperative time points and suggest that earlier postoperative development of continuity may be beneficial.
Authors:Darryl Lau, Vedat Deviren and Christopher P. Ames
This study examines how surgeon experience affects perioperative complications and quality measures following thoracolumbar 3-column osteotomy (3CO) in adult spinal deformity. This study is important because it helps identify complications associated with 3CO early in a surgeon's career and helps understand when surgeons overcome the learning curve.
Authors:Praveen V. Mummaneni, Paul Park, Christopher I. Shaffrey, Michael Y. Wang, Juan S. Uribe, Richard G. Fessler, Dean Chou, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Robert K. Eastlack, Pierce D. Nunley, Neel Anand, Michael S. Virk, Lawrence G. Lenke, Khoi D. Than, Leslie C. Robinson, Kai-Ming Fu and the International Spine Study Group (ISSG)
With new advances in minimally invasive surgery (MIS), the authors revised and updated the previously published MISDEF (minimally invasive spinal deformity surgery) algorithm. This updated algorithm was then validated. This is important because there is little consensus as to when MIS vs open surgery is appropriate. This algorithm provides a practical decision-making guide to practitioners.
Authors:Benjamin Kolb, John Large, Stuart Watson and Glyn Smurthwaite
The authors developed a novel prone positioning system able to cater to complex spine patients with advanced frailty and deformity, beyond the capacity of conventional prone positioning systems. This system allows surgery to be performed with the patient prone, eliminating the need for the sitting position, and moreover has marked benefits in terms of safety and economy.
Authors:Sakibul Huq, Jeffrey Ehresman, Ethan Cottrill, A. Karim Ahmed, Zach Pennington, Erick M. Westbroek and Daniel M. Sciubba
Researchers from Johns Hopkins conducted a systematic review of operative and nonoperative management strategies for Scheuermann kyphosis. Correction and maintenance of correction were higher in the surgical intervention group than the bracing group. Of the surgical patients, there has been a recent trend toward the increased use of a posterior-only versus combined anterior-posterior approach. The posterior-only approach provides similar or superior correction compared to the anterior-posterior approach, along with a milder complication profile and identical maintenance of correction.
Authors:Ekta Tiwari, Danielle M. Salvadeo, Alan S. Braverman, Nagat A. Frara, Lucas Hobson, Geneva Cruz, Justin M. Brown, Michael Mazzei, Michel A. Pontari, Amanda R. White, Mary F. Barbe and Michael R. Ruggieri Sr.
This study aimed to determine if nerve transfer after long-term decentralization restores lower urinary tract function in canines. This study is important for patients who sustain spinal cord or cauda equina injuries that prioritize recovery of bladder function.
Authors:Mahmoud Yousefifard, Solmaz Nasseri Maleki, Shaghayegh Askarian-Amiri, Alexander R. Vaccaro, Jens R. Chapman, Michael G. Fehlings, Mostafa Hosseini and Vafa Rahimi-Movaghar
There is controversy about the role of scaffolds as an adjunctive therapy to mesenchymal stem cell (MSC) transplantation in spinal cord injury (SCI). The findings of this study showed that scaffolds + MSCs is more effective than scaffolds and MSCs alone in improving motor function following SCI in animal models, when used in the acute phase of injury.
Authors:Hansen Deng, Andrew K. Chan, Simon G. Ammanuel, Alvin Y. Chan, Taemin Oh, Henry C. Skrehot, Caleb S. Edwards, Sravani Kondapavulur, Amy D. Nichols, Catherine Liu, John K. Yue, Sanjay S. Dhall, Aaron J. Clark, Dean Chou, Christopher P. Ames and Praveen V. Mummaneni
Surgical site infection (SSI) remains a notable cause of postoperative morbidity and mortality with current operative techniques and antiseptic protocols, indicating a clear need for improved understanding and reduction of the risk factors. Over a 4-year period at a major institution, the authors determined the rate of deep SSI in 2252 consecutive patients. They demonstrated that male sex, coronary artery disease, and diabetes were associated with increased SSI, whereas the implementation of presurgical chlorhexidine showers reduced SSI.
Authors:Lovepreet K. Mann, Jong H. Won, Nicholaus J. Trenton, Jeannine Garnett, Saul Snowise, Stephen A. Fletcher, Scheffer C. G. Tseng, Michael R. Diehl and Ramesha Papanna
Repair of spina bifida defects in utero does not benefit half of the children completely. This is typically due to incomplete closure of the defect. To improve on patient outcomes, a patch graft may be used. The authors found that patches made from cryopreserved human umbilical cords were superior in their healing properties to acellular dermal matrix patches. In summary, human umbilical cord patch repair of spina bifida defects may improve on patient outcomes.
The authors analyzed the impact of the L4–5 prosthetic positioning on functional results, which has not been done before. The prosthetic positioning can be chosen during surgery with the aid of fluoroscopic control. If a certain position provides better outcomes, the surgical technique can be improved to always reproduce the same accurate prosthetic positioning.
The authors analyzed two prospective studies of the five-repetition sit-to-stand (5R-STS) test for objective functional impairment (OFI) in patients with degenerative lumbar spinal disease, to evaluate whether the severity stratification for the recently proposed 5R-STS is valid and how the severity of OFI interacts with other patient-reported outcome measures. It is vital to improve understanding of the 5R-STS test as a new outcome measure because objective functional tests allow for quick and solid estimates of OFI in patients with degenerative lumbar pathologies.
The study evaluated how the core spine outcome measures used in clinical research differ in their ability to capture clinically important change. It is important because it identifies redundancies in the measurement of pain and discusses gaps in the current core battery. It suggests other key concepts that should be measured to track recovery from spine surgery.
Multiple factors are involved in characterizing patient satisfaction during a clinic visit. The authors performed a retrospective study of all spine surgeons in their health center to identify the important determinants that affect patient satisfaction. This updated framework will allow practices to target specific areas for improvement.
The authors compared the outcomes and demographics of patients with metastatic spine disease that was treated with radiation only or surgery with or without radiation to develop a pathway to improve patient care. These findings are important, as new treatments continue to emerge for the metastatic spine population, and research is needed to track outcomes in real time.
The authors developed optimal and safe spine MRI protocols for patients with deep brain stimulation devices for whom restrictions are usually in place in terms of MRI use. Thorough safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.
The authors evaluated the efficacy and toxicity of SSRS for patients with thyroid cancer and found that non–dose-escalated SSRS is capable of providing excellent long-term local control with minimal toxicity.
The authors compared two methods of interbody fusion—transsacral fixation and transforaminal lumbar interbody fusion—at the L5–S1 level in long fusion constructs in patients with adult spinal deformity. This study suggests that transsacral fixation may decrease potential instrument-related complications requiring revision while decreasing operating room time and implant-related costs compared to transforaminal lumbar interbody fusion.
The authors systematically reviewed databases of medical literature to identify studies of cauda equina syndrome and its incidence. This information is important for organizing healthcare services and especially out-of-hours imaging arrangements, as MRI is required for all patients with suspected cauda equina syndrome.
The authors studied the level of patient activation among patients who underwent cervical and lumbar spine surgery and found that patients who are highly active or engaged in their own care had subsequently greater satisfaction with their surgical care at 1 year postoperatively. This study is important because patient activation is an important metric of high-quality healthcare and is potentially modifiable through brief interventions.
Patients with cervical spondylotic myelopathy underwent surgery, and quantitative tests were used to determine the improvement in hand function and dexterity after surgery. This is the first prospective study to quantitatively assess the improvement in upper extremity function after surgery.
The authors describe the first two cases in world literature in which bilateral C2 pedicles were reconstructed in old hangman's fracture in which C2 pedicle was absent due to chronic fracture and reabsorption. One of the two cases (Case 2), is the first reported case of severe C2-3 spondyloptosis with C2 displaced up to the level of C4.
Instead of performing revision surgery for recurrent tethered cord syndrome, the authors shortened the spinal column to release the tension on the spinal cord, avoiding the scarred and previously operated upon area. By avoiding this area, risks of CSF leak, spinal cord injury from cord dissection, and wound healing problems are mitigated, hopefully decreasing complications from addressing recurrent adult tethered cord syndrome.
The authors monitored the radiation exposure of different members of the operating room staff by using a wearable personal dosimetry device that provides real-time feedback. Radiation exposure is not without risk, and traditional methods of radiation monitoring using biannual dosimetry badges do not provide real-time feedback that can effect strategic changes in the operating room. Real-time feedback using a personal dosimetry device may allow operating room staff to change their behaviors to decrease radiation exposure.
The authors analyzed associations between changes in depression/anxiety from before and 12 months after spine surgery, as well as changes in patient-reported outcomes (PROs) at the same time points. PROs were diminished among patients with persistent or new-onset depression or anxiety. These findings indicate a need to address the mental health of spine surgery patients because doing so may improve their postoperative PROs.
The authors tried to find associations of symptoms derived from spinal meningiomas with tumor location and size. Symptomatology of spinal meningiomas has never been studied in detail as much as in this article.
The authors conducted a systematic review of the adult literature to identify gender differences in clinical assessment scores before and after lumbar spine surgery. Identifying and reducing gender bias in medical decision-making and outcome reporting may facilitate equitable healthcare delivery; limited literature is available to guide the surgical management of lumbar spine disease, which differentiates on the basis of demographic factors (such as gender).
This is one of the largest studies regarding extracranial chordoma and chondrosarcoma. The analysis of this cohort gives some critical information on prognostic factors and optimization of treatment results. The degree of resection is of paramount importance for a patient’s outcome. If surgical stabilization is needed for these challenging patients, the authors’ data would suggest the use of carbon-reinforced polyetheretherketone-based implants.
Radiosurgery was delivered to the spinal dorsal root ganglion in a rat model using the Elekta Icon. Radiosurgery to the DRG of the lumbar spine was found to induce fibrosis and inhibit satellite glial cell activation while preserving axonal neurotransmission. These findings may lead to a novel, minimally invasive way to treat both back and leg pain.
The authors compared the minimal clinically important difference (MCID) threshold and the proportion of patients with adult spinal deformity (ASD) achieving an MCID on the Scoliosis Research Society 22-r questionnaire (SRS-22r) score in North America compared with Japan. The authors found significant differences in the proportion of patients with ASD achieving an MCID in the SRS-22r score between the two cohorts. The influence of culture on the clinical significance of patient-reported outcomes in patients with ASD has not been clearly established.
In this original manuscript, the authors determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic stimulation in determining satisfactory pedicle screw placement at C7. The main benefit to this technique is enhancing the safety of placing C7 pedicle screws, and potentially reducing the need to cross the cervicothoracic junction by achieving excellent fixation at C7.
The authors identified demographic and economic data associated with atlantoaxial fusion surgery to identify novel trends in utilization of the procedure to help inform future practice. These results suggest that this procedure is becoming more prevalent and safer. This information may guide presurgical shared decision-making.
The role of tranexamic acid and its safety as a surgical adjunct for long-segment spinal fusion are still unclear. The authors present one of the largest surgical series of first-time procedures and found that tranexamic acid can decrease intraoperative and postoperative blood loss significantly without increasing the risk.
The authors performed robot-assisted (RA) midline lumbar interbody fusion (MIDLIF) in a comparison with open traditional transforaminal lumbar interbody fusion (TLIF) and MIDLIF performed with navigation. RA-MIDLIF had the lowest operating room time, estimated blood loss, and length of stay and was comparable to TLIF and MIDLIF in terms of cost. This study shows promising results for using RA-MIDLIF as an alternative procedure for lumbar fusion.
Because the authors found that far greater pelvic retroversion was experienced by elderly patients with degenerative lumbar spondylolisthesis and severe knee osteoarthritis, and because lumbar short-segment fusion surgery alone may not be sufficient to improve the quality of life for these patients, the authors suggest that, in such cases, additional knee surgery should be considered to restore sagittal spinopelvic alignment.
In a retrospective review of all patients in a 5-year period who underwent multiple-level anterior cervical discectomy and fusion (ACDF), the authors examined rates of pseudarthrosis (nonunion) and reoperation in patients who received PEEK implants compared with those who received structural allograft implants. The results for multiple-level ACDF reinforce prior work on single-level ACDF at the same institution by similarly demonstrating significantly higher rates of nonunion and reoperation in patients who received PEEK than in patients who received structural allograft.
It is unclear if indirect decompression via interbody fusion alone is enough alleviate radiculopathy and claudication symptoms. Thus, the efficacy of indirect decompression remains unclear. In this study the authors evaluated factors that are associated with the need for additional posterior direct decompressive surgery after anterior lumbar interbody fusion or lateral lumbar interbody fusion. The findings show that in selected patients undergoing staged surgery, indirect decompression without direct decompression may be a reasonable option in treating degenerative spinal conditions.
The authors investigated the use of rotational thrombelastometry (ROTEM) during scoliosis surgery in pediatric patients. The results indicate that the use of ROTEM-guided blood product administration enables rapid diagnosis of coagulopathy and targeted therapy, which may reduce perioperative blood loss and the need for blood transfusion products and also shorten the length of stay in the ICU and hospital.
The authors investigated, for the first time, the biomechanical properties of C2 bicortical translaminar screw fixation and C2–3 transarticular screw fixation as alternative techniques to the Goel-Harms technique for atlantoaxial fixation. The authors believe that these new fixation techniques may serve as alternative procedures when the Goel-Harms technique is not feasible due to anatomical constraints.
Little is currently known about the uptake of cervical disc replacement (CDR) surgery in the general patient population. This study of American commercial insurance claims data suggests a substantial rise in the utilization of CDR for symptomatic single-level cervical spondylotic pathology between 2009 and 2017. The increase appears to have begun in 2013 and continued thereafter. Uptake of this new technology is much stronger in some regions of the United States than in others.
The authors retrospectively reviewed a large case series of spinal vascular malformations in the cervical spine from patients diagnosed and treated at their institution. This study is important because it is the largest single-institution case series on cervical spine arteriovenous malformations in the literature to date.
The authors evaluated the cost-effectiveness of a referral for postoperative physical rehabilitation in patients recovering from lumbar disc herniation. They found that a routine referral to physical rehabilitation was not cost-effective compared to no referral.
The authors conducted a prospective trial of cryoablation for head, neck, and spine tumors at their institution and performed an analysis of patients treated for metastatic spine disease. They found encouraging radiographic disease control, bone regrowth, and reductions in pain scores. Blood loss, hospital stay, and complications were all favorable. The readership may consider minimally invasive cryoablation as an option for patients burdened with metastatic spine disease.
To gain insight into the natural history and risk factors for traumatic vertebral artery injury (TVAI) in the geriatric population, the authors compared biometric, clinical, and imaging data for patients with TVAI evaluated at a level 1 trauma center and found that TVAI is associated with a significantly greater risk of mortality in the older adult population (age 65 years or older) than in the younger adult population, despite the 2 groups having similar Injury Severity Scores. Given the rapidly enlarging geriatric age group, increased understanding of how key pathologies affect this patient population differently is critical.
In the lumbar intervertebral foramina the adipose zone gradually tapers and rotates from the inferoposterolateral aspect to the superoanteromedial aspect, but its configuration in the upper lumbar intervertebral foramina was more complex than in the lower lumbar intervertebral foramina. The planning of an optimal transforaminal approach is different between the upper and lower lumbar intervertebral foramina, and in general it should be through the inferior compartment below the spinal ganglia or the superior endplate of the intervertebral disc.
The authors compared the outcomes of patients treated with spinal laser interstitial thermotherapy (SLITT) and open surgery for thoracic epidural metastatic spinal cord compression without neurological deficits. This is the first study to compare the conventional treatment to SLITT. The authors were able to demonstrate that SLITT is not inferior to open surgery regarding local control, with fewer complications and faster recovery time.
The authors investigated the relation between Hounsfield unit (HU) values measured on computed tomography and the risk of pedicle screw loosening in patients who underwent lumbar pedicle screw fixation for degenerative lumbar spine disease. The important findings that the HU value is significantly correlated with the incidence of screw loosening and can be used as an independent factor to predict screw loosening after pedicle screw fixation provide a basis for the application of HU values for surgical planning in the increasing number of patients with degenerative lumbar spine disease.
The results of this study of contusion injury and subsequent x-irradiation in rats indicate that x-irradiation in a region rostral to the injury epicenter is most critical for recovery of locomotor function. This minimal target is potentially therapeutic since it allows for a greatly reduced target volume so that uninjured tissue is not needlessly irradiated.
The authors used the Central Brain Tumor Registry of the United States database, which is provided by the Centers for Disease Control and Prevention, to document the incidence rates of spinal schwannomas in the United States between 2006 and 2014. The authors believe their article provides a comprehensive analysis of the population-based incidence of spinal schwannomas, which is necessary considering the paucity of population-based epidemiological studies reporting on this pathological entity.
In this study, using multiple health-related quality of life parameters, the authors showed that the surgical outcomes of lumbar spinal stenosis (LSS) patients with knee osteoarthritis (KOA) are favorable, although poorer than those of LSS patients without KOA, particularly in terms of returning to routine work or ordinary activities even after lumbar spinal surgery. This study is important because it indicated that the preoperative status of KOA should be considered when planning treatment for LSS patients and estimating the efficacy of lumbar spinal surgery.
The authors studied the epidemiology and morbidity of traumatic spine injuries related to sports in the pediatric population. This study is important since it can help providers and parents alike better identify risks associated with sports-related spine injuries and understand the prognosis of these injuries.